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For years, millions of Texans have known, through difficult personal experience, that health care in Texas has challenges. Over the last six COVID-scarred months, those issues have hit home for millions more.

Famously, or rather infamously, Texas leads the nation in the number of uninsured residents. Unfortunately, for well over a decade, the health care conversation in Texas has circled around this single statistic. Is health insurance coverage important? Of course. But as this pandemic has shown – an affordable, sustainable, effective health care system requires far more than insurance coverage.

Texas badly needs such a system, and future generations of Texans need leaders to get to work — today — creating it. Doing so requires setting aside politics, preconceptions, and past battles. It also means creating policy not only for the nearly 30 million people in this state right now, but also for the roughly 10 million more who will be here when we celebrate our bicentennial in 2036.

Texas 2036 was created to focus attention and energy on long-term, data-driven planning efforts and ensure Texas remains the best place to live and work a generation from now. That effort is rooted in health, which influences so much about Texans’ lives and the state’s economy.  By ensuring that our population is healthy, we are also ensuring that each Texan is able to participate fully in the economy and reach their potential.

Texas has not fared well on this front. According to America’s Health Rankings, we rank poorly on measures such as the prevalence of diabetes (41^st out of 50), cardiovascular deaths (34^th), and maternal mortality (43^rd). Texans can do better, as we have in reducing COVID cases recently and cancer deaths over time (we rank 11^th in the latter).

To achieve more systemic, and systematic success, Texas needs a data-driven, comprehensive approach to health that increases Texans’ access to the care when and where they need it. Besides coverage, that means looking at prevention, providers and prices as well.

It’s critical to look not only the plight of uninsured Texans, but also the roughly 80 percent of Texans who have coverage but can’t always access care.

Even for insured Texans, costs have become a significant barrier to health.  Texas health care spending jumped 13.8 percent between 2014 and 2018. Soaring costs leave more than a quarter of people with employer-sponsored health insurance “underinsured,” according to the Commonwealth Fund, with out-of-pocket costs and deductibles eating up big chunks of their income. Further, nearly a quarter of those not considered underinsured say they’ve skipped or delayed care due to cost.

A stronger health system also means having enough doctors, nurses and other providers to serve Texans who need care. This issue of access is especially acute in rural communities far removed from hospitals or even a doctor’s office — more than 100,000 Texans live in a county without a primary care physician.

Addressing coverage, cost and access demands a wide-ranging statewide conversation: everyone must be at the table, and everything must be on it. It means acknowledging government-funded insurance can’t solve everything and insurance doesn’t always equal care — but it also means maximizing the value of available resources, including federal dollars, to help Texans get care when and where they need it.

Along those lines, Texas 2036 has been collaborating with health care policy and financing experts to create a groundbreaking data tool looking at the cost and effectiveness of major policy options — Texas 2036 will release that tool, as well as broader health policy recommendations, in the coming months as the 2021 Texas legislative session approaches.

The most important person in this conversation is you. The state cannot create the comprehensive, sustainable, far-sighted system it needs without engaged citizens demanding solutions. Please visit www.texas2036.org and sign up for email updates about key policy issues shaping Texas’ future.

Together, we can create the health care system Texans need today — and will need even more tomorrow.

Margaret Spellings is Texas 2036’s president and CEO and former U.S. Secretary of Education. She recently served as president of the University of North Carolina System.